Juicebox Podcast: Type 1 Diabetes
Episode #1692 Bolus 4 – Thanksgiving
Host: Scott Benner
Guest: Jenny Smith
Date: November 26, 2025
Episode Overview
Theme:
Scott Benner and Jenny Smith break down practical strategies for insulin dosing (bolusing) during Thanksgiving. Using the Juicebox “Meal Bolt” framework, they examine how to approach bolusing for large, complex holiday meals featuring many high-carb and mixed-macronutrient foods. The conversation balances actionable guidance with real-world humor, aiming to help listeners navigate holiday eating without fear and with confidence.
Key Discussion Points & Insights
1. The Challenge of Thanksgiving Meals
- Thanksgiving Plates Are Carb Heavy: Most plates can range from 120 to over 200 grams of carbs, not counting dessert or drinks. Even moderate servings add up fast.
- Mixed Foods with Varied Glycemic Responses: Dishes like fresh-made vs. boxed stuffing and casseroles have differing impacts on blood glucose due to processing and added sugars/fats.
(03:08–06:18, 07:45–08:48) - Real-World Meal Choices: Nobody eats perfectly portioned, single-item foods at Thanksgiving. There are multiple sides, unknowns, and social distractions.
2. Estimating Carbs in Thanksgiving Dishes
- Common Item Estimates:
- Bread Stuffing: 40g per cup
- Mashed Potatoes: 35g per cup (a “fist-sized” portion)
- Sweet Potato Casserole: 55–60g per cup, high glycemic due to sugar/marshmallows
- Green Bean Casserole: 12–15g per cup
- Cranberry Sauce (canned): 22g for 1/4 cup, nearly all sugar
- Mac and Cheese: 32–45g per serving
- Dinner Rolls: 20g per piece; Cornbread: 26g per square
- Vegetable Sides: Brussels sprouts 12g/cup, glazed carrots 18g/half-cup
(02:18–10:46)
- Home-Cooked vs. Processed: Homemade versions often have a slower glycemic impact and are easier to estimate due to controllable ingredients. Processed or boxed versions can spike blood sugars faster and are harder to bolus for accurately.
(04:59–06:18)
3. How to Bolus for a Mixed, High-Carb Meal
- Sum it Up: A typical Thanksgiving plate can easily exceed 200g carbs, especially including dessert—so accurate estimation and dosing are crucial.
(14:01–15:18) - Don’t Bolus for Each Food Separately: At a meal like Thanksgiving, foods are eaten together over a prolonged period; consider total impact, not just item-by-item.
“A meal like this…you have to think about their impact together. All that is going into your gullet at one time and they all have a different impact.”
— Jenny, (12:35) - Meal Structure Matters: If possible, eat protein (e.g., turkey) first, then carbs, to buy insulin time to work.
“Start with the turkey or the proteins…you then at least build in a little time that the insulin is going to have to get moving before you have your sweet potatoes with marshmallows.”
— Jenny, (26:23)
4. Meal Bolt Formula & Pre-Bolusing Tips
Meal Bolt Steps:
- Measure the Meal: Total up carbs, protein, fat; consider glycemic index/load.
- Evaluate Yourself: What’s your BG? Insulin on board? Activity, stress, illness?
- Add the Base Units: Simple calculation: carbs ÷ insulin-to-carb ratio.
- Layer a Correction: Adjust for current BG.
- Build the Bolus Shape: 100% upfront for fast-absorbing, combo/split/extended for mixed meals.
- Offset the Timing: Pre-bolus (10–30 mins, depending on meal).
- Look at the CGM: Review at 1hr (spike?), 3hr (delayed), 5hr (lingering fat/protein).
- Tweak for Next Time: Learn from your curve.
(40:37–41:53)
Holiday Meal Example:
- Standard Strategy: If BG is 90–120 mg/dL, pre-bolus 20 minutes, dose 60–70% upfront, extend remaining 30–40% over 2–3 hours.
- Rising BG: Pre-bolus longer (25–30 mins). Add 10–20% insulin to the total dose or issue a correction bolus with no food considered.
- Falling BG: Start eating sooner or only give 50% upfront; deliver the rest over 2 hours.
- If Grazing for Hours: Increase temp basal by 10–25% (some do up to 25%) to compensate for sustained intake and estimation errors.
(18:31–20:38)
5. Estimation, Technology, and Practical Tips
- Lean on Tech: Use AI tools (like ChatGPT) or online calculators to break down recipes for more accurate carb counts.
“I just typed it into the machine and it’s giving it right back to me…so it’s valuable.”
— Scott, (22:32) - Extended Boluses Rock: For meals that are high-fat and high-complex carbs, extended/combo boluses help avoid both early spikes and late lows.
- If You’re Hosting/Busy: Erratic activity can make you more insulin sensitive—factor it in when bolusing.
- New Pump/CGM Users: Don’t use the very end of a sensor or site for Thanksgiving; change sites beforehand for best accuracy.
“Please put the tiniest bit of effort into making sure you're not in the last three hours of your CGM on Thanksgiving…”
— Scott, (37:20)
6. Common Pitfalls & Reassurance
- Fear of Large Boluses: Newly diagnosed or cautious parents may hesitate to give big (>80g) boluses.
“How do you find the nerve to make an 80-gram bolus when you’ve never done it before?”
— Scott, (35:46) “You could do an extended bolus…when you see it’s working but blood sugar is going up, you can always cancel an extended and take that as a normal bolus.”
— Jenny, (36:12) - Too Aggressive? Easy Fixes: Too much insulin? Quick carbs and desserts are abundant—easy to treat lows.
“This would be the time to drink the apple cider.”
— Jenny, (36:59) - CGM Alarms: Set LOW alerts higher (e.g., 80 mg/dL instead of 65–70) and HIGH alerts lower to spot issues early after a heavy meal or extended bolus.
(24:47–25:24)
7. Special Considerations
- Dessert Math: Pie with crust is ~50g carbs per slice (1/8th pie): about half crust, half filling.
“If you just want a nice round number: 50 grams for an eighth of a piece of pie.”
— Jenny, (32:41) - Alcohol & Sugary Drinks: Beer (Bud): 10.5g/can; Bud Light 6.6g; Apple cider: 30–40g/cup. Don’t drink your carbs if aiming for easier BG management.
(34:30–35:27) - Leftovers: Cold potatoes have a different, slower glycemic effect than hot potatoes—don't forget when going back for seconds.
(40:13–40:19) - Start the Day with Exercise: Helps with insulin sensitivity and tackling the heavy meal ahead.
Notable Quotes & Memorable Moments
-
On Thanksgiving Carb Totals:
“If you had a serving of each of these, you’re looking at…like you’re already up at 130 carbs...Even if you went with half a cup of this, you’re still 60–80 carbs.”
— Scott, (09:00) -
On Mixed Food Impact:
“A meal like this…we really have to consider it as a full effect meal.”
— Jenny, (13:39) -
On Using Technology:
“I just typed it into the machine and it’s giving it right back to me…so it’s valuable.”
— Scott, (22:32) -
On Pre-bolusing and Meal Timing:
“Get up in the morning, get ahead and stay ahead. Use increased temp basals, make sure to pre-bolus those first couple things you’re eating…and you should have insulin on your side.”
— Scott, (23:26) -
On Dessert Bolusing:
“Would you normally do this if you just sat down to a piece of pumpkin pie? No…but because of the meal on top of this in your belly…”
— Jenny, (34:30) -
On Fear and Learning:
“It’s a ballsy move, it really is. Is there a way to go into it slowly?”
— Scott, (36:10) “You could do an extended bolus…and when you see it’s been working but now blood sugar is going up, you can always cancel an extended bolus and take that as a normal bolus.”
— Jenny, (36:12)
Timestamps for Important Segments
- Thanksgiving Food List & Carb Estimates: 02:18–10:46
- Impact of Cooking Methods (Homemade vs. Processed): 04:59–06:18
- Meal Bolt Recipe Example, Full Plate Calculation: 14:01–15:18
- Holistic Meal Impact (Not Bolusing for Items Separately): 12:35–14:01
- Meal Bolt Framework Applied to Thanksgiving: 18:31–20:38
- Using Technology for Carb Calculation: 22:32–23:26
- Dessert (Pies) Breakdown: 29:14–33:13
- Handling Large Boluses for the First Time: 35:46–36:59
- Final Tips (CGM, Exercise, Leftovers, Drinks): 37:20–40:30
- Meal Bolt Framework Recap & Outro: 40:37–41:53
Summary Table: Example Thanksgiving Plate (Approximate Carbs)
| Food Item | Estimated Carbs | |--------------------------|-----------------| | Bread Stuffing (1 cup) | 40g | | Mashed Potatoes (1 cup) | 35g | | Sweet Potato Casserole | 55–60g | | Green Bean Casserole | 12–15g | | Mac and Cheese | 32–45g | | Dinner Roll | 20g | | Glazed Carrots | 18g | | Turkey (3 oz) | ~0g | | Gravy (1/4 cup) | 6g | | TOTAL (w/ all above) | 218–236g | | Pumpkin Pie Slice (1/8) | 50g |
Tone & Approach
The banter is engaging, light-hearted, and sometimes self-deprecating, with practical explanations and real-life anecdotes. Scott and Jenny prioritize flexibility, reassurance, and the idea that perfection isn’t necessary—empowering listeners to experiment, learn, and not fear the insulin.
Final Takeaways:
- Pre-bolus and stay ahead: Don’t wait for the spike. Use pre-bolusing, temp basals, and extended boluses as needed.
- Estimate, but don’t be afraid: Large holiday meals require more insulin and more flexibility.
- Learn and adjust: “Tweak for next time.”
- Lean on technology: Use CGMs, AI tools, and calculators for more accuracy.
- Enjoy the holiday! Don’t let diabetes spoil Thanksgiving.